Journal of Musculoskeletal Trauma

Analysis of the Changes in Femoral Varus Bowing and the Factors Affecting Nonunion for the Treatment of Femoral Shaft Fractures over 60 Years Old Using Piriformis Fossa Insertion Intramedullary Nailing: Yonghan Cha, Chan Ho Park, Jun-Il Yoo, Jung-Taek Kim, WooSuk Kim, Ha-Yong Kim, Won-Sik Choy; J Korean Fract Soc 2020;33(2):65-71. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.65

Purpose
This study examined the bony morphological changes to analyze the factors affecting bony union in the treatment of elderly femoral shaft fractures with varus bowing using piriformis fossa insertion intramedullary nailing.
Materials and Methods
This study included 26 patients over 60 years of age, who were admitted for femoral shaft fractures between January 2005 and December 2014 and treated with piriformis fossa insertion intramedullary nailing. Age, sex, height, weight, bone mineral density, injury mechanism, fracture type, diameter and length of the nail, postoperative lengthening of the femur, postoperative change in varus angle, contact between the lateral and anterior cortex, and the gap between the fracture line and the bony union were checked. The patients were divided into a varus group and nonvarus group, as well as a bone union group and nonunion group. Logistic regression analysis was performed to analyze the factors affecting nonunion.
Results
The patients were classified into 11 in the varus group and 15 in the non-varus group and 24 in the union group and 2 in the nonunion group. The varus group showed a larger increase in leg length and varus angle reduction than the non-varus group (p<0.05). The union group had more contact with the lateral cortical bone than that of the nonunion group (p<0.05). The factor affecting bone union in regression analysis was contact of the lateral cortical bone (p<0.05).
Conclusion
Treatment of a femoral shaft fracture in elderly patients with a varus deformity of the femur using piriformis fossa insertion intramedullary nail increases the length of the femur and decreases the varus deformity. For bony union, the most important thing during surgery is contact of the lateral cortical bone with the fracture site.

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Straight nail insertion through a laterally shifted entry for diaphyseal atypical femoral fractures with bowing: good indications and limitations of this technique
Seong-Eun Byun, Young-Ho Cho, Young-Kyun Lee, Jung-Wee Park, Seonguk Kim, Kyung-Hoi Koo, Young Soo Byun
International Orthopaedics.2021; 45(12): 3223. CrossRef

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Results of Single Small Incision Minimally Invasive Plate Osteosynthesis in the Treatment of the Distal Radius Fractures: Young Sung Kim, Jong Pil Kim, Phil Hyun Chung, Ho Min Lee, Bo Sung Go; J Korean Fract Soc 2020;33(2):72-80. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.72

Abstract PDF: Purpose
This study compared minimally invasive plate osteosynthesis (MIPO) using a single small skin incision and conventional open volar locking plate fixation (OP) for distal radius fracture to identify outcome difference.
Materials and Methods
Forty-three patients who underwent MIPO using a single small skin incision or OP for distal radius fractures were evaluated retrospectively. Of the patients, 21 were treated with MIPO using a single small skin incision and 22 with the OP method through the conventional volar approach. The postoperative radiographic results and clinical outcomes at the final follow-up in each group were compared.
Results
All patients achieved bone union in the MIPO and OP groups. No significant differences in the bone union time, alignment, range of motion, QuickDASH, or pain score were observed. On the other hand, the size of the incision was significant: 23 mm in the MIPO group and 55 mm in the OP group (p<0.001).
Conclusion
MIPO technique using a single small incision showed similar satisfactory radiographic and functional outcomes compared to conventional OP for distal radius fractures. The MIPO technique using a single small incision offered advantages, including cosmetic benefits and minimal soft tissue damage, is recommended, particularly in young women and high functional demand patients.

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Usefulness of Sonication in Implant-Related Infection: Jae Hyeon Seo, Mi Na Kim, Ji Wan Kim; J Korean Fract Soc 2020;33(2):81-86. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.81

Abstract PDF

Purpose
This study determined whether the sonication of explants could improve the detection of bacteria and influence the optimal antibiotics treatment.
Materials and Methods
This retrospective study included the patients who underwent implant removal surgery followed by sonication culture as well as tissue culture in order to diagnose implant-related infection. A total of 37 consecutive patients with 41 cases were included. The patients’ demographic data, use of preoperative antibiotics, type of implants, change of antibiotics following the culture results, and recurrence of infection were all reviewed.
Results
Among 41 cases, 20 cases met the diagnostic requirements for implant-related infection as defined by musculoskeletal infection society criteria, while the other 21 cases had explant sonication to exclude indolent infection or residual infection. The latter showed negative results on the both explant cultures and tissue cultures. Among the 20 cases that met the requirements for implant-related infection, 19 cases (95.0%) were identified by any cultures. Of the 19 cases with positive culture results, 2 cases (10.5%) showed positive results only on sonication cultures, and one case (5.3%) showed positive results only on tissue culture. In 1 case of culture negative implant-related infection, a drain sinus was present preoperatively, but the cultures were negative according to both methods. The culture results made postoperative antibiotics change in 12 cases among the 19 culture (+) cases. Antibiotics changes were based on the tissue culture in 2 cases, 2 cases were based on the sonication culture, and the remaining 8 cases were based on both cultures.
Conclusion
The sonication culture improved the diagnosis of implant-related infection combined with conventional tissue culture and helped to determine administering the proper antibiotics.

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Systematic Diagnosis and Treatment Principles for Acute Fracture-Related Infections
Jeong-Seok Choi, Jun-Hyeok Kwon, Seong-Hyun Kang, Yun-Ki Ryu, Won-Seok Choi, Jong-Keon Oh, Jae-Woo Cho
Journal of the Korean Fracture Society.2023; 36(4): 148. CrossRef

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Three-Dimensional Analysis of the Morphological Features in the Femur of Atypical Fracture and Practical Implications of Intramedullary Nailing: Yong Uk Kwon, Kyung-Jae Lee, Joo Young Choi, Gu-Hee Jung; J Korean Fract Soc 2020;33(2):87-95. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.87

Abstract PDF: Purpose
This study analyzed the morphological features of the contralateral femur without an atypical fracture by constructing a three-dimensional model with an actual size medullary canal.
Materials and Methods
Lateral and anterior bowing of the shaft were measured for 21 models, and the shape of the medullary canal was analyzed. To eliminate the projection error, the anteroposterior (AP) femur was rotated internally to the extent that the centerline of the head and neck, which is the ideal position of cephalomedullary nail screw, was neutral, and the lateral femur matched the medial and lateral condyle exactly.
Results
The lateral bowing and anterior bowing was an average of 5.5° (range, 2.8°-10.7°; standard deviation [SD], 2.4°) and 13.1° (range, 6.2°-21.4°; SD, 3.2°), respectively. In the area where lateral bowing increased, the lateral cortex became thicker, and the medullary canal was straightened. On the lateral femur, the anterior angle was increased significantly, and the diameter of curvature averaged 1,370.2 mm (range, 896-1,996 mm; SD, 249.5 mm).
Conclusion
Even if the anterolateral bowing increases in the atypical femur, the medullary canal tends to be straightened in the AP direction. So, it might be considered as a reference to the modification of an intramedullary nail to increase the conformity.

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Femoral Head Fracture with Hip Dislocation Treated by Autologous Osteochondral Transfer (Mosaicplasty) - A Case Report -: Eui-Sung Choi, Hyun-Chul Shon, Ho-Seung Jeong, Jae-Young Yang, Seok-Hyun Hong, Byung-Hyun Ahn; J Korean Fract Soc 2020;33(2):96-100. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.96

Abstract PDF

Femoral head fractures combined with hip dislocation are very rare injuries. In most cases, they result from high-energy trauma to the hip or lower extremity during traffic accidents. Various therapy options have been suggested to treat these injuries. Especially, different joint-preserving surgical options have been described for the treatment of traumatic osteochondral injury of the femoral head in young, active patients. In this report, we present a case that a traumatic osteochondral lesion to the femoral head after hip dislocation was treated with osteochondral autografts (OATS) from the non-weight-bearing area of the ipsilateral inferior femoral head through a surgical hip dislocation. After 1 year, the clinical and radiological outcome was satisfactory with no evidence of posttraumatic osteoarthritis and no pain of patients.

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Femoral head fracture with large crushed defect in weight-bearing area treated with autologous osteochondral transplantation (repositionplasty): A case report
Hyun-Chul Shon, Eic-Ju Lim, Jae-Young Yang, Seung-Jun Jeon
Medicine.2022; 101(52): e32569. CrossRef

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Treatment of Atypical Ulnar Fracture Associated with Bisphosphonate Therapy - A Case Report -: Dong-Soo Kim, Ji-Kang Park, Eui-Sung Choi, Ho-Seung Jeong, Seok-Hyun Hong, Byung-Hyun Ahn; J Korean Fract Soc 2020;33(2):101-104. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.101

Abstract PDF: Bisphosphonates can cause atypical fractures when taken for a long time. Atypical fractures appear mainly as femoral subtrochanteric or shaft fractures. On the other hand, reports of atypical fractures in the proximal ulna are relatively rare, with a high proportion of nonunion cases. This paper reports a case of nonunion after fixation for atypical fractures of the proximal ulna.

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Intraspinal Extradural Cyst Subsequent to a Vertebral Compression Fracture - A Case Report -: Byeong Yeol Choi, Jong Eon Choi; J Korean Fract Soc 2020;33(2):105-109. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.105

Abstract PDF: Although a rare entity, intraspinal extradural cyst can cause severe deficit via neural compression. After reviewing available literature, the authors report a rare case of cord compression by intraspinal extradural cystic mass that developed after an osteoporotic vertebral compression fracture. An 80-year-old female patient had undergone vertebroplasty for osteoporotic vertebral compression fracture of T12, subsequent to a minor fall. However, the patient complained about sustained pain and progressive weakness of lower extremities even after the procedure. Follow-up magnetic resonance imaging revealed an intraspinal extradural cystic lesion compressing the spinal cord, and the patient had to undergo a surgical intervention via the posterior approach. Symptoms were relieved postoperatively, with no recurrence during the 1-year follow-up.

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Treatment of Periprosthetic Fracture after Total Elbow Replacement Arthroplasty: Hyunseok Seo, Jin-Hyung Im, Joo-Yup Lee; J Korean Fract Soc 2020;33(2):110-117. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.110

Abstract PDF

The indications for total elbow replacement arthroplasty (TERA) include rheumatoid arthritis, degenerative arthritis, acute fracture, nonunion, malunion, posttraumatic arthritis, tumor, and chronic instability. With the development of designs and the increasing use of TERA, more periprosthetic fractures are occurring. On the other hand, there is less data on periprosthetic fractures after TERA because TERA is a relatively rare procedure. Thus, a careful review of the previous literature and appropriate selection of surgical indications are essential for achieving a satisfactory outcome, which should be accompanied by precise surgery as planned. This article presents the causes, risk factors, classification, and principles of treatment of periprosthetic fractures after TERA.

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Intramedullary fibula strut bone allograft in a periprosthetic humeral shaft fracture with implant loosening after total elbow arthroplasty
Young-Hoon Jo, Seung Gun Lee, Incheol Kook, Bong Gun Lee
Clinics in Shoulder and Elbow.2020; 23(3): 152. CrossRef

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Periprosthetic Fracture after Total Shoulder Arthroplasty: Nam Su Cho, Myung Seo Kim, Jae Woo Yang, Jeung Hwan Seo, Dong Won Seo; J Korean Fract Soc 2020;33(2):118-123. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.118

Abstract PDF: Periprosthetic humeral fractures in patients with total shoulder arthroplasty are rare and difficult to treat. With the significant increase in the number of older patients who have undergone total shoulder arthroplasty in recent years, an increase in the number of periprosthetic shoulder fractures can be estimated. The decisions of treatment have to be taken individually, depending on the stability of the prosthesis, fracture location, and bone quality. On the other hand, there are limited data for treatment guidance and outcomes. This paper reviews the risk factors, classification, treatment, and outcomes of periprosthetic humeral fractures.

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